Cargando…
Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study
BACKGROUND: There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19). METHODS: We conducted a multi-center, retrospective analysis in 23 Indian transplant cent...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8948372/ https://www.ncbi.nlm.nih.gov/pubmed/35350707 http://dx.doi.org/10.1016/j.eclinm.2022.101359 |
_version_ | 1784674647104552960 |
---|---|
author | Kute, Vivek B. Ray, Deepak S. Aziz, Feroz Godara, Suraj M. Hegde, Umapati KumarBT, Anil Bhalla, Anil K. Yadav, Dinesh Kumar Singh, Sarbpreet Pathak, Vivek Dalal, Sonal Bahadur, Madan M. Anandh, Urmila Abraham M, Abi Siddini, Vishwanath Das, Sushree Sashmita Thukral, Sharmila Krishnakumar, Arvind Sharma, Ashish Kher, Vijay Bansal, Shyam B. Shingare, Ashay Narayanan, Ranjit Patel, Himanshu Gulati, Sanjeev Kakde, Shailesh Bansal, Dinesh Guleria, Sandeep Khullar, Dinesh Gumber, Manoj R. Varyani, Umesh Guditi, Swarnalatha Khetan, Prakash Dave, Rutul Mishra, Vineet V. Tullius, Stefan G. Chauhan, Sanshriti Meshram, Hari Shankar |
author_facet | Kute, Vivek B. Ray, Deepak S. Aziz, Feroz Godara, Suraj M. Hegde, Umapati KumarBT, Anil Bhalla, Anil K. Yadav, Dinesh Kumar Singh, Sarbpreet Pathak, Vivek Dalal, Sonal Bahadur, Madan M. Anandh, Urmila Abraham M, Abi Siddini, Vishwanath Das, Sushree Sashmita Thukral, Sharmila Krishnakumar, Arvind Sharma, Ashish Kher, Vijay Bansal, Shyam B. Shingare, Ashay Narayanan, Ranjit Patel, Himanshu Gulati, Sanjeev Kakde, Shailesh Bansal, Dinesh Guleria, Sandeep Khullar, Dinesh Gumber, Manoj R. Varyani, Umesh Guditi, Swarnalatha Khetan, Prakash Dave, Rutul Mishra, Vineet V. Tullius, Stefan G. Chauhan, Sanshriti Meshram, Hari Shankar |
author_sort | Kute, Vivek B. |
collection | PubMed |
description | BACKGROUND: There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19). METHODS: We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR. We also performed competing risk analysis. Additional outcome measures included graft loss, all-cause mortality, waiting time from a positive real-time polymerase test (RT-PCR) to KT, laboratory parameters, and quality of life in follow-up. FINDINGS: Among 372 KT which included 38(10·21%) ABO-incompatible, 12(3·22%) sensitized, 64(17·20%) coexisting donors with COVID-19 history and 20 (5·37%) recipients with residual radiographic abnormalities, the incidence of AR was 34 (9·1%) with 1(0·26%) death censored graft loss, and 4(1·07%) all-cause mortality over a median (interquartile range) follow-up of 241 (106–350) days. In our cox hazard proportional analysis, absence of oxygen requirement during COVID-19 compared to oxygen need [HR = 0·14(0·03–0·59); p-value = 0·0071], and use of thymoglobulin use compared to other induction strategies [HR = 0·17(0·03–0.95); p-value = 0·044] had a lower risk for AR. Degree of Human leukocyte antigen (HLA) DR mismatch had the highest risk of AR [HR = 10.2(1·74–65·83); p-value = 0·011]. With competing risk analysis, with death as a competing event, HLA DR mismatch, and oxygen requirement continued to be associated with AR. Age, gender, obesity, inflammatory markers, dialysis vintage, steroid use, sensitization and ABO-incompatibility have not been associated with a higher risk of AR. The median duration between COVID-19 real time polymerase test negativity to transplant was 88(40–145) days (overall), and ranged from 88(40–137), 65(42–120), 110(49–190), and 127(64–161) days in World Health Organization ordinal scale ≤ 3, 4, 5, and 6–7, respectively. There was no difference in quality of life, tacrolimus levels, blood counts, and mean serum creatinine assessed in patients with a past COVID-19 infection independent of severity. INTERPRETATION: Our findings support that the outcomes of KT after COVID-19 recovery are excellent with absence of COVID-19 sequelae during follow-up. Additionally, there does not seem to be a need for changes in the induction/immunosuppression regimen based on the severity of COVID-19. FUNDING: Sanofi |
format | Online Article Text |
id | pubmed-8948372 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-89483722022-03-25 Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study Kute, Vivek B. Ray, Deepak S. Aziz, Feroz Godara, Suraj M. Hegde, Umapati KumarBT, Anil Bhalla, Anil K. Yadav, Dinesh Kumar Singh, Sarbpreet Pathak, Vivek Dalal, Sonal Bahadur, Madan M. Anandh, Urmila Abraham M, Abi Siddini, Vishwanath Das, Sushree Sashmita Thukral, Sharmila Krishnakumar, Arvind Sharma, Ashish Kher, Vijay Bansal, Shyam B. Shingare, Ashay Narayanan, Ranjit Patel, Himanshu Gulati, Sanjeev Kakde, Shailesh Bansal, Dinesh Guleria, Sandeep Khullar, Dinesh Gumber, Manoj R. Varyani, Umesh Guditi, Swarnalatha Khetan, Prakash Dave, Rutul Mishra, Vineet V. Tullius, Stefan G. Chauhan, Sanshriti Meshram, Hari Shankar EClinicalMedicine Articles BACKGROUND: There is an enormous knowledge gap on management strategies, clinical outcomes, and follow-up after kidney transplantation (KT) in recipients that have recovered from coronavirus disease (COVID-19). METHODS: We conducted a multi-center, retrospective analysis in 23 Indian transplant centres between June 26, 2020 to December 1, 2021 on KT recipients who recovered after COVID-19 infections. We analyzed clinical and biopsy-confirmed acute rejection (AR) incidence and used cox-proportional modeling to estimate multivariate-adjusted hazard ratios (HR) for predictors of AR. We also performed competing risk analysis. Additional outcome measures included graft loss, all-cause mortality, waiting time from a positive real-time polymerase test (RT-PCR) to KT, laboratory parameters, and quality of life in follow-up. FINDINGS: Among 372 KT which included 38(10·21%) ABO-incompatible, 12(3·22%) sensitized, 64(17·20%) coexisting donors with COVID-19 history and 20 (5·37%) recipients with residual radiographic abnormalities, the incidence of AR was 34 (9·1%) with 1(0·26%) death censored graft loss, and 4(1·07%) all-cause mortality over a median (interquartile range) follow-up of 241 (106–350) days. In our cox hazard proportional analysis, absence of oxygen requirement during COVID-19 compared to oxygen need [HR = 0·14(0·03–0·59); p-value = 0·0071], and use of thymoglobulin use compared to other induction strategies [HR = 0·17(0·03–0.95); p-value = 0·044] had a lower risk for AR. Degree of Human leukocyte antigen (HLA) DR mismatch had the highest risk of AR [HR = 10.2(1·74–65·83); p-value = 0·011]. With competing risk analysis, with death as a competing event, HLA DR mismatch, and oxygen requirement continued to be associated with AR. Age, gender, obesity, inflammatory markers, dialysis vintage, steroid use, sensitization and ABO-incompatibility have not been associated with a higher risk of AR. The median duration between COVID-19 real time polymerase test negativity to transplant was 88(40–145) days (overall), and ranged from 88(40–137), 65(42–120), 110(49–190), and 127(64–161) days in World Health Organization ordinal scale ≤ 3, 4, 5, and 6–7, respectively. There was no difference in quality of life, tacrolimus levels, blood counts, and mean serum creatinine assessed in patients with a past COVID-19 infection independent of severity. INTERPRETATION: Our findings support that the outcomes of KT after COVID-19 recovery are excellent with absence of COVID-19 sequelae during follow-up. Additionally, there does not seem to be a need for changes in the induction/immunosuppression regimen based on the severity of COVID-19. FUNDING: Sanofi Elsevier 2022-03-25 /pmc/articles/PMC8948372/ /pubmed/35350707 http://dx.doi.org/10.1016/j.eclinm.2022.101359 Text en © 2022 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Articles Kute, Vivek B. Ray, Deepak S. Aziz, Feroz Godara, Suraj M. Hegde, Umapati KumarBT, Anil Bhalla, Anil K. Yadav, Dinesh Kumar Singh, Sarbpreet Pathak, Vivek Dalal, Sonal Bahadur, Madan M. Anandh, Urmila Abraham M, Abi Siddini, Vishwanath Das, Sushree Sashmita Thukral, Sharmila Krishnakumar, Arvind Sharma, Ashish Kher, Vijay Bansal, Shyam B. Shingare, Ashay Narayanan, Ranjit Patel, Himanshu Gulati, Sanjeev Kakde, Shailesh Bansal, Dinesh Guleria, Sandeep Khullar, Dinesh Gumber, Manoj R. Varyani, Umesh Guditi, Swarnalatha Khetan, Prakash Dave, Rutul Mishra, Vineet V. Tullius, Stefan G. Chauhan, Sanshriti Meshram, Hari Shankar Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study |
title | Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study |
title_full | Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study |
title_fullStr | Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study |
title_full_unstemmed | Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study |
title_short | Management strategies and outcomes in renal transplant recipients recovering from COVID-19: A retrospective, multicentre, cohort study |
title_sort | management strategies and outcomes in renal transplant recipients recovering from covid-19: a retrospective, multicentre, cohort study |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8948372/ https://www.ncbi.nlm.nih.gov/pubmed/35350707 http://dx.doi.org/10.1016/j.eclinm.2022.101359 |
work_keys_str_mv | AT kutevivekb managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT raydeepaks managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT azizferoz managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT godarasurajm managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT hegdeumapati managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT kumarbtanil managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT bhallaanilk managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT yadavdineshkumar managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT singhsarbpreet managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT pathakvivek managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT dalalsonal managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT bahadurmadanm managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT anandhurmila managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT abrahammabi managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT siddinivishwanath managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT dassushreesashmita managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT thukralsharmila managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT krishnakumararvind managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT sharmaashish managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT khervijay managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT bansalshyamb managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT shingareashay managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT narayananranjit managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT patelhimanshu managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT gulatisanjeev managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT kakdeshailesh managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT bansaldinesh managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT guleriasandeep managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT khullardinesh managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT gumbermanojr managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT varyaniumesh managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT guditiswarnalatha managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT khetanprakash managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT daverutul managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT mishravineetv managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT tulliusstefang managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT chauhansanshriti managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy AT meshramharishankar managementstrategiesandoutcomesinrenaltransplantrecipientsrecoveringfromcovid19aretrospectivemulticentrecohortstudy |